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1045 W Main Suite C Walnut Ridge AR 72476 | |
(870) 886-8300 | |
(870) 886-8302 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1045 W Main, Walnut Ridge, Arkansas |
Authorized Official Name and Position | Roger Lee Troxel (PRESIDENT) |
Authorized Official Contact | 8708868300 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 777 Walnut Ridge AR 72476-0777 Ph: (870) 886-8300 | 1045 W Main Suite C Walnut Ridge AR 72476 Ph: (870) 886-8300 |
NPI Number | 1356480818 |
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Provider Enumeration Date | 02/05/2007 |
Last Update Date | 10/26/2009 |
Medicare PECOS PAC ID | 0547436487 |
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Medicare Enrollment ID | O20111227000646 |
Identifier | Type | State | Issuer |
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1356480818 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | C8313 (Arkansas) | Primary |
Provider Name | Roger L Troxel |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1669575569 PECOS PAC ID: 3375520711 Enrollment ID: I20111227000682 |
Provider Name | Sandra L Troxel |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1003274275 PECOS PAC ID: 9133424278 Enrollment ID: I20160226001177 |
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